Auditory Processing Disorder: Protocols and Controversy.

PURPOSE: This study examined current auditory processing disorder (APD) protocols and audiologists' perspectives on the active debate seen in the literature regarding the status of APD as a unique disorder. METHOD: This study used a cross-sectional, nonexperimental survey design. The participants were 134 U.S. audiologists, representing diversity across experience level and work setting. RESULTS: Popular APD tests from prior surveys remain popular, and a few new tests have emerged. Most audiologists use diverse strategies to identify potential comorbid disorders as part of their APD protocol, including multidisciplinary assessment and referral to other specialists. Most participants disagreed with the assertion that APD is not a unique disorder; however, many also pointed out that patients' struggles with listening need to be the primary focus of APD assessment and management, regardless of the label of the disorder. Qualitative analysis of participant comments on the controversy yielded six themes: Clinical Experience, Comorbidity, Listening Skills, Literature Support, Overdiagnosis, and More Information Needed. CONCLUSION: Most participants consider APD to be a unique disorder, citing clinical experience and the literature for support; however, many also indicated APD is complicated by comorbidity and APD may be overdiagnosed.

Audiology Clinical Practice Patterns in Acoustic Reflex Testing.

PURPOSE: Periodic reports of audiology clinical practice patterns, including acoustic reflex threshold (ART) protocols, provide insights into trends and assist in clinical decision making. Therefore, the purpose of this study was to examine audiologists' ART protocols, factors influencing audiologists' decision to test, and considerations for mentoring Doctor of Audiology (AuD) students in ART testing. METHOD: This study used a paper survey distributed by mail to a random sample of audiologists. Participants were 102 audiologists, representing diversity across age, clinical experience, and work setting. The survey asked participants to provide (a) demographics, (b) ART protocols, (c) rationale for ART testing, and (d) perspectives on mentoring of ART testing. RESULTS: When ART testing is conducted, 100% of respondents conduct ipsilateral ART testing, compared to 75% for contralateral testing. Most use 500-, 1000-, and 2000-Hz stimulus frequencies, and 56% report 4000 Hz. Patient-related factors are the primary reason participants cite for conducting, or not conducting, ART tests. Most supervisor-participants encourage AuD students to conduct ART tests, based on patient-centered and student learning-centered reasons, and use a variety of strategies to guide students when ART findings are unusual. CONCLUSIONS: Fewer than half (43%) of participants conduct ART testing for all new patients, suggesting it is ancillary to the standard test battery for most participants. When ART testing is conducted, ipsilateral testing only or a combination of ipsilateral and contralateral testing is used. Ongoing trends in ART testing include continued popularity of 500-2000 Hz and ipsilateral-only or ipsilateral plus contralateral testing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21513987.

Burnout in U.S. Audiologists.

BACKGROUND: Research on burnout in audiologists is limited, especially in the United States. Recent changes to the profession may have increased burnout. PURPOSE: The purpose was to investigate burnout in the U.S. audiologists in diverse work settings. RESEARCH DESIGN: This study used three surveys: demographics/workplace stressors, Maslach Burnout Inventory (MBI), and professional quality of life (ProQOL). STUDY SAMPLE: Participants were 149 U.S. audiologists. Participants were diverse regarding experience, work setting, and location. DATA COLLECTION AND ANALYSIS: The first survey provided demographics, perspectives on over-the-counter (OTC) hearing aids, stressors, and stress rating. The MBI assessed three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The ProQOL assessed burnout, compassion fatigue, and compassion satisfaction. Analyses included descriptive and inferential statistics of quantitative data and thematic analysis of qualitative data. RESULTS: Audiologists had low burnout, low compassion fatigue, and high compassion satisfaction. Experience was not related to stress rating; however, more experienced audiologists had greater compassion satisfaction and lower burnout, emotional exhaustion, and depersonalization compared with less experienced audiologists. Concern about OTC hearing aids was associated with stress rating. Thematic analysis identified 11 stressors, with 50% of stressors classified under work duties, time, and patients. CONCLUSION: The U.S. audiologists had low burnout rates. Burnout was greatest in less experienced audiologists. Stress was not related to experience. Stressors included insufficient time to see patients, heavy caseload, time-consuming administrative tasks, pressure to sell hearing aids, and stressful interpersonal communication.

Change Resistance and Clinical Practice Strategies in Audiology.

BACKGROUND: Audiology is experiencing pressure from market forces that may change the profession's nature. Research suggests that understanding resistance needs to change and organizational culture may provide insights that can facilitate change. PURPOSE: This study was designed to examine audiologists' resistance to change, organizational culture, and clinical practices related to hearing aid pricing and audiology assistants. RESEARCH DESIGN: This study utilized a cross-sectional and nonexperimental survey design. STUDY SAMPLE: Participants were 205 U.S. audiologists, representing diversity across experience, work setting, and location. DATA COLLECTION: This survey examined demographics and clinical practice strategies. Resistance to change (RTC) scale examined disposition toward change. Organizational culture profile (OCP) examined organizational culture perspectives. RESULTS: The majority (52%) of respondents use bundled pricing but 42% of these repondents anticipate transitioning to unbundling. Use of hybrid pricing is increasing. Service-extender personnel were reported by 41%. Although the majority (66%) do not work with audiology assistants currently, 32% of these participants anticipate they will do so in the future. Results indicated lower RTC and greater years of experience were associated with more positive perceptions about organizational culture. Pricing structure was related to experience. CONCLUSION: Trends indicate use of bundled pricing is decreasing, use of hybrid pricing is increasing, and employment of audiology assistants is increasing. Experienced audiologists are more likely to report unbundled and hybrid pricing compared with less experienced audiologists.

Occupational Stress in U.S. Audiologists.

PURPOSE: The goal of this study was to explore interview data related to occupational stress in U.S. audiologists. This study is part of a larger project: The Lived Experience of the Audiologist, which seeks to develop a richer understanding of audiologists' lived experience via interview and survey research. METHOD: Demographic and interview data related to occupational stress were examined from 28 virtual interviews of clinical audiologists in the United States. Qualitative data relative to workplace stressors were subjected to thematic analysis. Stress ratings were examined via descriptive statistics, correlation, and comparison with demographics. RESULTS: Self-ratings of average-day and worst-day stress were not related to work setting, years of experience, or U.S. region. Participant descriptions of workplace stressors yielded seven main themes: time, patients, administration, financial, lack of support, colleagues, and work-life balance. Some participants attributed stress response to personality traits. CONCLUSIONS: Audiologists' quotes illustrate the human impact of stressors in the workplace. The most commonly reported workplace stressors were lack of time, patient-related issues, administration, and financial issues. Time and administration as common causes of stress were consistent with prior studies conducted in other countries; however, patient-related and financial stressors were more prominent stressors for U.S. audiologists. Stress ratings were not related to work setting, location, or years of experience in the current study. Participants often linked their perception of stress to personality traits, a phenomenon that has been explored as a factor in the exploration of occupational stress in other fields, but not in audiology. Future research in stress and burnout should examine personality traits in addition to extensive demographics.

The Lived Experience of the Audiologist: Connections Between Past, Present, and Future.

PURPOSE: The purpose of the study was to use qualitative research methods to explore connections between audiologists' lived experiences and perceptions of the future and change. METHOD: This research was based on a constructivist grounded theory approach. A semistructured interview guide inspired 30 audiologists to share their stories via virtual interview. A theoretical framework evolved from grounded theory analysis techniques. RESULTS: The majority of audiologists interviewed in this study entered audiology via the undergraduate-stumble pathway, usually after leaving speech-language pathology. This pathway was associated with poorer perceptions of the future compared with early-purposeful and later-purposeful pathways. Generation differences, value juxtaposition, professional identity, and student debt also influenced perspectives of the future. Participants described high value-of-self relative to patient care and joy stories associated with meaningful relationships with patients. Most participants reported responding actively to changes in the marketplace at the individual work setting level; however, change response was complex and difficult to quantify when broader issues impacting the profession were considered. Participants expressed concern about the future, including the need to address high student debt, perceived lack of unity across the profession, and value-by-others. CONCLUSION: Grounded theory exploration of the lived experience of 30 audiologists supported a theoretical framework that connects perceptions of the future with origin story, generation perspectives, value juxtaposition, professional identity, and student debt.

Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

BACKGROUND: Large discrepancies exist in the literature regarding definition, diagnostic criteria, and appropriate assessment for auditory processing disorder (APD). Therefore, a battery of tests with normative data is needed. PURPOSE: The purpose of this study is to collect normative data on a variety of tests for APD on children aged 7-12 yr, and to examine effects of outside factors on test performance. RESEARCH DESIGN: Children aged 7-12 yr with normal hearing, speech and language abilities, cognition, and attention were recruited for participation in this normative data collection. STUDY SAMPLE: One hundred and forty-seven children were recruited using flyers and word of mouth. Of the participants recruited, 137 children qualified for the study. Participants attended schools located in areas that varied in terms of socioeconomic status, and resided in six different states. DATA COLLECTION AND ANALYSIS: Audiological testing included a hearing screening (15 dB HL from 250 to 8000 Hz), word recognition testing, tympanometry, ipsilateral and contralateral reflexes, and transient-evoked otoacoustic emissions. The language, nonverbal IQ, phonological processing, and attention skills of each participant were screened using the Clinical Evaluation of Language Fundamentals-4 Screener, Test of Nonverbal Intelligence, Comprehensive Test of Phonological Processing, and Integrated Visual and Auditory-Continuous Performance Test, respectively. The behavioral APD battery included the following tests: Dichotic Digits Test, Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test, Compressed and Reverberated Words Test, Auditory Figure Ground (signal-to-noise ratio of +8 and +0), and Listening in Spatialized Noise-Sentences Test. Mean scores and standard deviations of each test were calculated, and analysis of variance tests were used to determine effects of factors such as gender, handedness, and birth history on each test. RESULTS: Normative data tables for the test battery were created for the following age groups: 7- and 8-yr-olds (n = 49), 9- and 10-yr-olds (n = 40), and 11- and 12-yr-olds (n = 48). No significant effects were seen for gender or handedness on any of the measures. CONCLUSIONS: The data collected in this study are appropriate for use in clinical diagnosis of APD. Use of a low-linguistically loaded core battery with the addition of more language-based tests, when language abilities are known, can provide a well-rounded picture of a child's auditory processing abilities. Screening for language, phonological processing, attention, and cognitive level can provide more information regarding a diagnosis of APD, determine appropriateness of the test battery for the individual child, and may assist with making recommendations or referrals. It is important to use a multidisciplinary approach in the diagnosis and treatment of APD due to the high likelihood of comorbidity with other language, learning, or attention deficits. Although children with other diagnoses may be tested for APD, it is important to establish previously made diagnoses before testing to aid in appropriate test selection and recommendations.

Assessment of the efficacy of a hearing screening program for college students.

BACKGROUND: The Towson University (TU) Speech-Language-Hearing Center (SLHC) conducts annual hearing screenings for college students entering education or health-care professions. Hearing is screened in therapy rooms, and students who fail the screening are rescreened in a sound-treated booth. Students who fail the rescreening are referred for a comprehensive audiological assessment, which is offered at no cost to students at the SLHC. PURPOSE: The purpose of this study was to examine the efficacy of the hearing screening program, to report trends in hearing screening statistics for the college student population, and to make recommendations regarding ways universities can optimize hearing screening programs. RESEARCH DESIGN: The study included retrospective and prospective portions. Hearing screening records were reviewed from 1999 to 2011. The prospective study involved recruiting students to participate in diagnostic testing following the hearing screening and measuring background noise levels in the therapy rooms. STUDY SAMPLE: Hearing screening records from 1999 to 2011 were reviewed. In addition, during the three-day fall 2011 hearing screenings, 80 students were selected to participate in diagnostic testing. DATA COLLECTION AND ANALYSIS: Data from the retrospective review were used to determine positive predictive value (PPV) between screening and rescreening. Return rates were also examined. For the prospective study, pure tone threshold results were compared to screening results to determine sensitivity, specificity, and PPV. RESULTS: The retrospective file review indicated that the hearing screening in the therapy room had poor PPV compared with the rescreening in the sound booth. Specifically, if a student failed the screening, they had only a 49% chance of failing the rescreening. This may have been due to background noise, as the prospective study found noise levels were higher than allowed by American National Standards Institute (ANSI) standard. Only a third of students referred for diagnostic testing from 1999 to 2010 returned for recommended diagnostic testing. For the prospective study, specificity and sensitivity were good when considering hearing loss present at the same frequencies as those screened (1000, 2000, 4000 Hz) but poor in comparison to hearing loss overall. The screening missed many students with a high frequency notch, which was most prevalent at 6000 Hz. The prevalence of a high frequency notch was 21 and 51%, using two different criteria for establishing the presence of a notch. CONCLUSIONS: If college hearing screenings are conducted in rooms that are not sound treated, poor PPV should be expected; thus, an immediate second stage rescreening for failures should be conducted in a sound booth. Hearing screenings limited to 1000, 2000, and 4000 Hz will miss many cases of hearing loss in the college-age population. College hearing screening program directors should carefully consider the purpose of the screening and adjust screening protocol, such as adding 6000 Hz and a question about noise exposure, in order to identify early signs of noise-induced hearing loss in college students. Programs should focus on ways to promote high return for follow-up rates. Estimates of prevalence of a high-frequency audiometric notch are highly dependent on the criteria used to define a notch.

Development of a formative and summative assessment system for AuD education.

PURPOSE: This article provides an overview of a comprehensive assessment system that documents that students have obtained the skills and knowledge necessary to obtain a Doctor of Audiology (AuD) degree. METHOD: The individual components of the assessment system; rationale for development of each assessment; and grading criteria, outcomes measures, faculty commentary, missteps, and successes of the system are discussed. CONCLUSION: Carefully planned and dynamic assessments can be integrated successfully into the AuD students' program of study with generally reasonable expectations for faculty workload. It is crucial for program directors to continually assess the system used to document student learning and to make modifications based on formal and informal feedback from students, faculty, alumni, evidence based clinical practice, and clinical preceptors.

Deaf studies alumni perceptions of the academic program and off-campus internship.

Alumni of an undergraduate Deaf studies program completed an online survey about their education and employment after graduation and their perceptions of their internship and undergraduate academic program. Demographically, this population of Deaf studies alumni represented a higher percentage of women and dual-major graduates than was present in the general university population. It was found that most of the alumni reported using the knowledge and skills from the Deaf studies program in their current job. Current employment among alumni was almost 100%, and most of the alumni had positive perceptions regarding their personal, academic, and professional growth as it related to their internship and undergraduate Deaf studies program. The study findings underscore the need for continued support of Deaf studies programs. Suggestions are provided for program directors regarding the development of internships and academic programs for students in Deaf studies.

The awareness of the profession of audiology among entering college students.

PURPOSE: The purpose of this study was to develop and pilot test a survey of entering college students' awareness of the profession of audiology and to report the preliminary results of the survey. METHOD: A survey was developed and administered in 2003 at the California University of Pennsylvania. A modified survey was administered in 2009. Survey questions asked students to identify what audiologists do and the education requirements to become an audiologist. RESULTS: Seventeen percent of the students self-reported that they knew what an audiologist did and were able to accurately describe the profession. Approximately 30% of the students learned about audiology from family/friends. Students reported selecting their major based on interest in a specific field and not on market-driven forces such as job opportunities and salary. CONCLUSION: Future surveys should be conducted to confirm the extent of the lack of visibility of audiology as a profession and to serve as a metric for the efficacy of future marketing efforts in the profession.

Survey of audiological immittance practices.

PURPOSE: The purpose of this study was to examine current immittance practices and trends over time, reasons why multifrequency (MF) and multicomponent (MC) tympanometry have been underused, and the prevalence of negative patient reactions to acoustic reflex (AR) testing. METHOD: Two audiological practice surveys were conducted regarding tympanometry (2008, n = 156) and AR (2009, n = 90). RESULTS: Most respondents conduct tympanometry and AR threshold (ART) testing. MF and MC tympanometry were rarely reported, generally due to a lack of equipment and training. ART testing was reported most often using both ipsilateral and contralateral presentation. Contralateral testing has decreased over time. Patient complaints of discomfort following AR testing were common. Complaints of tinnitus or hearing loss were present, although rare. CONCLUSION: Tympanometry and ART tests have remained popular for the past 30 years, whereas acoustic reflex decay (ARD) testing has decreased in popularity. MF and MC tympanometry are conducted infrequently. AR is frequently associated with discomfort but rarely associated with other symptoms. However, one respondent reported that AR testing had caused permanent tinnitus and hearing loss.

Survey of the diagnosis and management of auditory processing disorder.

PURPOSE: A survey of audiologists' diagnosis and intervention protocols for auditory processing disorder (APD) was conducted to determine current protocols and compare results with published recommendations. METHOD: A survey was distributed by mail to 515 American Speech-Language-Hearing Association audiology members who listed APD as an area of expertise and via e-mail to Educational Audiology Association members. The survey was completed by 195 audiologists. RESULTS: The majority of respondents reported using auditory processing (AP) test batteries selected based on clinical experience, review of the literature, and attendance at professional conferences. The most popular tests were dichotic, monaural low-redundancy speech, and temporal processing tests. Treatment and management recommendations were usually customized for each patient based on deficits found in behavioral AP testing. The majority of respondents indicated that audiologists are responsible for APD diagnosis (97%) and recommendation of treatment/management (81%); in contrast, only 40% of respondents indicated audiologists were responsible for providing treatment/management. CONCLUSIONS: Audiologists are selecting AP test batteries based on the age and case history of the patient, which is in accordance with recent national guidelines. Audiologists are primarily responsible for APD diagnosis and recommending treatment/management. APD treatment is provided by speech-language pathologists, educators, and audiologists.

Effect of static force on bone conduction hearing thresholds and comfort.

OBJECTIVE: To assess the effect of the static force of a bone vibrator on the results of bone conduction (BC) threshold measurements and comfort. DESIGN: BC thresholds were determined for 40 participants using the standardized P-3333 headband and a leather adjustable headstrap with variable static forces (2.4, 3.4, 4.4, 5.4 N). Comfort ratings were examined using a five-point Likert scale. RESULTS: Mean BC thresholds were within ± 2 dB across all conditions; differences may be considered small enough to be clinically insignificant. Participants experienced significantly greater discomfort with the P-3333 versus the adjustable headstrap. The mean static force of the P-3333 varied considerably and was higher in situ than the calibration standard of 5.4 N. CONCLUSIONS: The results suggest that future revisions of relevant international and national standards should address the use of an adjustable headstrap and a static force less than 5.4 N.

Speech intelligibility and passive, level-dependent earplugs.

OBJECTIVES: Noise-induced hearing loss is one of the most common occupational diseases. Military personnel are at especially high risk due to the broad range of military noise hazards and the frequency of exposure. Hearing protectors are vital for this particular workforce, yet they can impede the ability to understand necessary communication in the field. Level-dependent hearing protectors are designed to protect the auditory system from the hazards of impulse noise, while preserving the ability to hear speech and other important auditory signals. The aim of this study was to evaluate the effect of two different passive, level-dependent earplugs (Combat Arms Earplugs; Sonic II Ear valves) on speech understanding of normal-hearing listeners in the presence of low-level background noise. The Combat Arms Earplug, developed specifically for use by military personnel, represented devices that attenuate impulse noise using small orifices and the Sonic II ear valve represented devices using an internal diaphragm. DESIGN: This study used a repeated-measures experimental design. Four scrambled lists of each of the four Northwestern University No. 6 50-word lists were presented in random order at 65 dB SPL in the presence of quiet and two different types of background noise: multitalker and military vehicle noise; using three ear conditions: NP (open ear), CA (Combat Arms Earplugs), and SO (Sonic II earplugs); and three signal-to-noise ratios (SNRs): -10, 0, and +10 dB. Word recognition scores (WRSs) of 18 native English-speaking adults with normal hearing sensitivity were measured in all test conditions. The percentage of words correctly repeated was used to determine differences between the two different level-dependent devices, types of background noise, and SNRs. RESULTS: Results showed a statistically significant increase in WRS as SNR increased from -10 to +10 dB. A repeated-measures analysis of variance for ear condition × noise × SNR indicated a significant main effect for SNR but not for type of noise or ear condition. A slight but significant interaction was found for SNR and ear condition. CONCLUSIONS: SNR had great impact on the ability of listeners to understand speech in the presence of background noise; however, the type of noise and the type of level-dependent device used did not. The results of the study support the notion that individuals potentially subjected to high-level impulse noise should be able to use level-dependent earplugs in low-level continuous noise without compromising speech understanding. More specifically, the passive, level-dependent earplugs currently used by military personnel do not appear to be detrimental to speech communication for listeners with normal hearing when the speech is at an average conversational level and the listener is actively attending to the signal.

The AuD program at Towson University.

PURPOSE: This article provides an overview of the Towson University doctor of audiology (AuD) program. METHOD: Faculty and facilities, program highlights and requirements, admission criteria, and funding opportunities are summarized. CONCLUSIONS: Towson University is a student-focused university with an emphasis on interactive and interdisciplinary hands-on learning. The physical facilities include an active on-campus clinic and newly renovated facilities that are equipped with the latest diagnostic, treatment, research, and teaching equipment. Off-campus clinical rotations occur at state-of-the-art health care facilities in the Baltimore-Washington, DC, corridor and surrounding areas. Fourth-year externships include facilities across the United States. The AuD program includes a 104-credit curriculum combining didactic, clinical, and research courses. A comprehensive assessment system tracks progress throughout the program to ensure graduates are well prepared for entry into the profession as autonomous audiologists.

Automated screening for biological weapons in homeland defense.

Biological threat detection programs that collect air samples and monitor for large-scale release of biowarfare agents generate large numbers of samples that must be quickly and accurately screened for the presence of biological agents. An impediment to the rapid analysis of large numbers of environmental biological samples is that manual laboratory processes are time-consuming and require resources to maintain infrastructure, trained personnel, and adequate supplies of testing reagents. An ideal screening system would be capable of processing multiple samples rapidly, cost-effectively, and with minimal personnel. In the present study, we evaluated the Automated Biological Agent Testing System (ABATS) to explore the capability of automation to increase sample throughput, maximize system accuracy, and reduce the analysis costs associated with biological threat agent screening in environmental samples. This study demonstrates the utility of this concept and the potential of an automated system to address the growing environmental monitoring needs of the United States.

The auditory processing battery: survey of common practices.

A survey of auditory processing (AP) diagnostic practices was mailed to all licensed audiologists in the State of Maryland and sent as an electronic mail attachment to the American Speech-Language-Hearing Association and Educational Audiology Association Internet forums. Common AP protocols (25 from the Internet, 28 from audiologists in Maryland) included requiring basic audiologic testing, using questionnaires, and administering dichotic listening, monaural low-redundancy speech, temporal processing, and electrophysiologic tests. Some audiologists also administer binaural interaction, attention, memory, and speech-language/psychological/educational tests and incorporate a classroom observation. The various AP batteries presently administered appear to be based on the availability of AP tests with well-documented normative data. Resources for obtaining AP tests are listed.